Abstract: PO2154
Guiding Kidney Transplant Candidates for Effective Weight Loss
Session Information
- Transplantation: Clinical - Underrecognized Risk Factors, Traditional Considerations, and Outcomes
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Kukla, Aleksandra, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Diwan, Tayyab S., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Collazo-Clavell, Maria L., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Lorenz, Elizabeth C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Clark, Matthew M., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Denic, Aleksandar, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Park, Walter, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Schinstock, Carrie A., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Amer, Hatem, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Smith, Byron H., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Issa, Naim S., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Bentall, Andrew J., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Dean, Patrick G., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Kudva, Yogish C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Mundi, Manpreet, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Stegall, Mark D., Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background
Acceptance criteria at most transplant centers for waitlisting include BMI. The best approach to weight loss to facilitate active listing is unknown.
Methods
We aimed to determine the weight loss, listing, and transplant rates in 28 candidates with a mean BMI of 44.4 (4.6) and diabetes treated conservatively for obesity for 1-year post weight loss consultations, where the surgical and non-surgical weight loss options were discussed. A comparator group (n= 15) included patients with the mean BMI of 43.1 (4.4) who had bariatric surgery by 1 year post consultation.
Results
The mean BMI at 1-year follow-up in the studied group (n=28) was 43.0 (4.8), and total body weight loss was 4.4 (8.2) kg (3.6% (6.5). BMI has not improved at 2 years (p=0.8; Figure 2A). Eighteen patients (64%) remained ineligible for a transplant due to excess weight and/or comorbidities over a mean follow-up of 4.0 (2.9) years. Most patients (75%) did not achieve an acceptable BMI for transplant. In contrast, total body weight decreased by 22.18 (10.1) kg (19% (7%)) at 6 months post-bariatric surgery with the BMI of 34.2 (4) and 32.5 (3.7) at 6 and 12 months, respectively (Figure 2B). Bariatric surgery was associated with subsequent kidney transplantation (HR = 5.75; CI [1.49, 22.14]; p = 0.01).
Conclusion
A conservative weight loss approach was ineffective in most kidney transplant candidates with diabetes to improve access to transplantation. These data suggest the need for larger controlled trials.
Baseline characteristics
Factor | No bariatric surgery | Bariatric surgery | p value | All |
Age at evaluation | 52.3 (11.9) | 53.0 (9.2) | 0.83 | 52.5 (11) |
Male gender | 15 (53.6%) | 5 (33.3%) | 0.20 | 20 (46.5%) |
BMI at weight loss consultation | 44.4 (4.6) | 43.1 (4.4) | 0.37 | 43.9 (4.5) |
Dialysis | 14 (51.9%) | 9 (60.0%) | 0.61 | 23 (54.8%) |
Diabetes type 2 (vs. type 1) | 23 (82.1%) | 14 (93.3%) | 0.31 | 37 (86%) |
Follow up (years) | 4.5 (3.1) | 3.6 (2.2) | 0.29 | 4.1 (2.8) |
Data presented as Mean (SD), or N (%). BMI=body mass index.